修復物周囲う蝕の評価における 2 つの視覚的基準の精度：遅延型横断的研究

Accuracy of two visual criteria for the assessment of caries around restorations: a delayed-type cross-sectional study.

抄録

本研究の目的は、永久歯の修復物周囲のう蝕の検出に用いられる 2 つの視覚的基準の性能を比較することであった。この遅延型横断研究において、研究サンプルは、修復物の評価のための以下の2つの視覚的基準のうちの1つにランダムに割り当てられた：a）FDI基準（国際歯科連盟；限界染色、限界適応、および齲蝕再発を考慮）、およびb）国際齲蝕分類および管理システムによって定義されるCARS（Caries Associated with Restorations or Sealants）基準。i) 手術が必要な修復物（修復・再置換）については，修復物の一部または全部を除去し，う蝕組織の有無を評価し， ii) 手術を必要としない修復物については，ベースラインで検出されなかった新しい病変の存在を確認できるよう1年間のフォローアップを推奨する，という二つの基準で校正済み検査者が修復物を評価した．基準の感度，特異度，ROC曲線下面積（Az），精度が評価された．本研究では，305件の修復物が対象となった．FDIマージナルステインパラメータのAz値が最も低く（Az = 0.501），CARS（62.0%），FDIう蝕存在パラメータ（65.0%），FDIマージナル適応パラメータ（74.0%）の感度はほぼ同じであった．CARS は最も高い特異度（88.3%）と正確度（85.6%）を示した．修復物周囲のう蝕の検出では，CARS 基準がより高い特異度と精度を示し，う蝕の再発とマージナル適応では FDI 基準がそれに続いた．二次う蝕の評価にマージナルステインを考慮したり，複数のマージナルフィーチャーを組み合わせたりすると，偽陽性や過剰治療のリスクが高くなることが示された．

The aim of this study was to compare the performance of two visual criteria used for the detection of caries around restorations in permanent teeth. In this delayed-type cross-sectional study, the study sample was randomly allocated to one of two visual criteria for the assessment of restorations, as follows: a) FDI criteria (International Dental Federation; considers marginal staining, marginal adaptation, and caries recurrence), and b) CARS (Caries Associated with Restorations or Sealants) criteria, defined by the International Caries Classification and Management System. A calibrated examiner assessed the restorations using two reference standards, as follows: i) for restorations requiring operative interventions (repair/replacement), the restoration was partially or totally removed and the presence or absence of carious tissue was assessed; and ii) for restorations requiring non-operative intervention, follow-up for a period of one year was recommended to allow identification of the presence of new lesions not detected at baseline. The sensitivity, specificity, area under Receiver Operating Characteristic (ROC) curve (Az), and accuracy of the criteria were assessed. The study included 305 restorations. The FDI marginal staining parameter had the lowest Az value (Az = 0.501), while similar sensitivity was observed between the CARS (62.0%), FDI presence of caries (65.0%), and FDI marginal adaptation (74.0%) parameters. CARS exhibited the highest specificity (88.3%) and accuracy (85.6%). The CARS criteria exhibited better specificity and accuracy in detecting caries around restorations, followed by the FDI criteria for caries recurrence and marginal adaptation. Considering marginal staining or combining multiple marginal features to assess secondary caries resulted in an increased risk of false-positive outcomes and over-treatment.